TUESDAY, April 30, 2019 (Pharmacist's Briefing) -- People who use combination nicotine replacement therapy (NRT) are more likely to successfully quit smoking than people who use a single form of NRT, according to a review published online April 18 in the Cochrane Database of Systematic Reviews.
Nicola Lindson, Ph.D., from the University of Oxford in the United Kingdom, and colleagues conducted a systematic literature review to identify studies evaluating the effectiveness and safety of different forms, deliveries, doses, durations, and schedules of NRT for achieving long-term smoking cessation.
The researchers identified 63 trials with 41,509 participants. They determined with high-certainty evidence that combination NRT (fast-acting form plus patch) results in higher long-term quit rates than the single form (relative risk [RR], 1.25; 95 percent confidence interval [CI], 1.15 to 1.36; based on 14 studies, 11,356 participants). Moderate-certainty evidence showed that patches with 42/44 mg are as effective as 21/22 mg (24-hour; RR, 1.09, 95 percent CI, 0.93 to 1.29; five studies, 1,655 participants) and that 21-mg patches are more effective than 14-mg patches (24-hour; RR, 1.48; 95 percent CI, 1.06 to 2.08; one study, 537 participants). A benefit was noted for the higher-dose gum in five studies (4 mg versus 2 mg; RR 1.43; 95 percent CI, 1.12 to 1.83; 856 participants), although subgroup analysis suggests that only smokers who are highly dependent may benefit. Moderate-certainty evidence indicated a favorable effect of preloading (using NRT prior to quit day) on abstinence (RR, 1.25; 95 percent CI, 1.08 to 1.44; nine studies, 4,395 participants). Using either a form of fast-acting NRT or a nicotine patch results in similar long-term quit rates based on high-certainty evidence (RR, 0.9; 95 percent CI, 0.77 to 1.05; eight studies, 3,319 participants).
"This high-quality evidence clearly signposts that the most effective way to use NRT is to use a combination of two products at once, a patch and a fast-acting form such as gum, nasal spray, or lozenge," Lindson said in a statement.
Two authors were involved in included trials of NRT preloading.